Provider Demographics
NPI:1366195166
Name:PRESTON, REBECCA JANE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 FORESTER LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2726
Mailing Address - Country:US
Mailing Address - Phone:813-205-8529
Mailing Address - Fax:
Practice Address - Street 1:4249 FORESTER LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2726
Practice Address - Country:US
Practice Address - Phone:813-205-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician